The operative technique for combined fusion of the knee and rotationplasty of the limb in the management of congenital deficiency of the femur is presented. The technique described allows earlier definitive prosthetic fitting of a child with proximal femoral deficiency; it has reduced the number of operative procedures needed to obtain the optimal function from that deficient limb; and it has enabled these procedures to be performed at an earlier age. The technique differs from those previously described and represents a significant improvement in management of the patient with femoral deficiency.

Sixty-nine patients with congenital abnormality of the femur were reviewed. Their manifestation of femoral dysplasia ranged from an intact femur approximately 60 per cent of the length of the normal leg to a subtotal absence of the femur in which only the femoral condyles remained, often with a congenital fusion of the knee joint. Two groups were defined: Group I consisted of those with congenital hypoplastic femur in which the hip and knee could be made functional and where, in some patients at least, leg equalisation was possible; Group II consisted of those with true proximal focal femoral deficiency where the hip joint was never normal and the knee joint was always useless. The patients in each group were examined and evaluated with respect to clinical signs, surgical procedures performed, and prosthetic requirements and function. A protocol of treatment for both groups is suggested.

Fifty-nine children with juvenile idiopathic scoliosis have been reviewed. In six of eighteen who had no treatment the curvatures did not increase over eighteen months or more, while in twelve they increased at a median annual rate of six degrees. The pattern and magnitude of the curvature and the age at diagnosis could not be used accurately to predict progression. In forty-two patients progression occurred and Milwaukee brace treatment was begun, thirty being managed with periods of part-time wear. The median correction was 13 per cent. Serial measurements of the rib-vertebra angle difference (RVAD) were useful to predict a tendency to progress. Part-time wear of the brace was successful in cases where the RVAD values fell towards zero or became negative with treatment. Sixteen patients required surgical treatment; all had high positive RVAD values. However, with the plan of brace treatment outlined, part-time wear controlled many of the curvatures.

Homologous blood transfusions are not without risks, especially in young women and girls. In patients undergoing certain elective surgical procedures autologous blood transfusion is a good alternative. Normovolaemic haemodilution in association with autotransfusion offers the additional advantages of reduced loss of red cell mass during the operation and an increase in tissue blood flow. In this study twenty-seven adolescent patients undergoing Harrington instrumentation for idiopathic scoliosis had haemodilutional autotransfusions during their operations, none requiring homologous blood. Eighteen were given an average of 750 millilitres of homologous blood in the postoperative period which compared favourably with controls who required 1280 millilitres.

This paper describes a simple method for the recording of rib deformity in idiopathic scoliosis. The relationships have been recorded between the measured rib hump and rib depression deformities and 1) the rotation of the vertebral bodies (as measured by the method of Nash and Moe on the standing radiograph); 2) the degree of lateral curvature (as measured by the method of Cobb on the standing radiograph); and 3) the rib-vertebra angles and their differences (as described by Mehta). No clear linear relationships were found. Many examples of irregular relationship were recorded, for example, marked spinal rotation with minimal rib hump. The response of the rib deformities to treatment by Milwaukee brace in fifty-two patients is described; the hump is little changed but the depression on the opposite side may be considerably reduced. Harrington instrumentation may have a similar effect.